This course will explain why it is important for hospitals to develop technical evaluation and management (E/M) guidelines for reporting outpatient emergency department medical visits to the Centers for Medicare and Medicaid Services (CMS). Covered topics include: guidelines for reporting coverage and separately-reportable services use of modifiers specific requirements for types of services such as ED, clinic, or critical care visits definitions of Type A and Type B facilities explanation of excepted and non-excepted provider-based off-campus clinics.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Section 1: Introduction
About This Course
Section 2: Hospital Internal Guidelines
AHA and AHIMA Recommended Guidelines
Models for Emergency Department E/M Technical Guidelines
Basics of Facility Guidelines
Distribution of Visits
Section 3: ED Type
Emergency Departments: Type A and Type B
Section 4: Visit Type
Packaged Critical Care Ancillary Services
Trauma Activation Payment
Section 5: Payment
Payment for Emergency Department and Clinic E/M Levels
Reporting Emergency Department E/M Levels
Services Included in Facility-Based Emergency Department E/M Guidelines
Separately Reportable (Billable) Procedures
Modifier -25 Reporting
Modifier -25 Example
Section 6: Telehealth Services
Telehealth Services Overview
Section 7: Conclusion
Reviewer: Veronica Ziac, MBA
Alison has twenty-nine years of healthcare and information system experience, eleven of those years consulting at hospitals across the United States. Her areas of expertise include all aspects of Soarian Financials Revenue Management including Service Catalog (CDM), Service Maps, CRDT, General Ledger, Contracts, Claims, Reports, and all Master Files. Alison has provided analysis and reconfiguration for optimization, new build services, legacy support for hospital systems moving to a new platform, and training.Disclosure: Alison Kazmierczak has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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